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Vaughn, Isabell NEW YORK STATE DEPARTMENT OF HEALTH OFFICIAL BURIAL (OR REMOVAL) PERMIT This permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District if (Town, Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERT -- FICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No. S ( 7 Town, Village Dist. No. ' County or City If city, give street address) Name of deceased '2—v't-v � '`— Veteran (If veteran, give name of War) Single, married,widowed, Sex or divorced (write the word) Date of Death 19 Age _� l Years Months Days Birthplace Cause of Death Certificate was signed by M.D. Address Place of Burial (or Removal) _ (If body is to be temporarily held, fill io sn space later 'Cemetery i"� �---- � Date of Burial 19 (If body is to be temporarily held, fill in space later) The CERTIFICATE OF DEATH containing the above stated particulars, having been presented to me, after careful examination, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registration, have recorded it in my Local Record with the above stated Registered Number, and on the basis thereof I HERE- BY GRANT A PER{..�MI�T to )¢r - (Name) (Address) the to hold temporarily ant the body Unlert��/ljkr o •ers'n having charge of corpse) -re or o erwise di�gpose of (state how)) Date 19Z_ (Signed) l Local Registrar This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required. FORM Vs. 61. (REV. 6/63) (6A2.130) ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHICH INTERMENTS OR CREMATIONS ARE MADE Date of was 7 19 -77 (Interment orY.46,-L4 Cremation) 7.-0-e- (Name of Cemetery, Crematorium, etc.) Section �� Lot No. Grave No. (Signed) � �� � (Person in Charge) Address Person in charge must return this Permit to the Registrar of his District within SEVEN (7) DAYS from above date. If no person is in charge, the FUNERAL DIRECTOR or UNDERTAKER MUST SIGN ABOVE STATEMENT, write across the face of the Permit the words "No person in charge," and FILE PERMIT WITHIN THREE (3) DAYS with the Registrar of District in which cemetery is located. SEXTONS, FUNERAL DIRECTORS and UNDER- TAKERS violating the law relative to the return of permits are liable to a penalty of NOT LESS THAN FIVE DOL- LARS NOR MORE THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law will be enforced. Local Regis- trars are required, under penalty, to report violations thereof. Np w r A" NEW YORK STATE DE NT OF HEALTH OFFICIAL BURIAL ( • ' I „ VAL) PERMIT t ISF This permit can be signed only by the Local Registrar g or subregistrar) of the Primary Registration District (Town, Village, or City) in which the death occurred after the F d acceptance of a CORRECT AND COMPLETE CERTI- FICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BL' 4'4s" 3` Registered No. I 1 rage Dist. No. _ __�.-'l.___--- County U._.1 Ct.r v e,.• I LI.,e1d- . .t.4,� 'nsks r cl.c.7 If city, give street address) Name of deceased ---a--- s abe 1 ) a c A �m a Veteran rl V 2 } :Vd'ilr (If veteran, give name of War) Single, married,widowed, " e, / Sex _.._f.er...�.1. or divorced (write the word.,.sq Date of Death 3-/2 - 192 Age -2 Years Months l. r% Birthplace 'N e - 'a,_ Cause of Death ..`._t-'_v._ _-n. 0..-, sc,—___ID._bas-i-f,-g o. . Certificate was signed by . `z--- _ti__,, I... .CA:>r,.,_ *, -� M.D. Address �v �p u l 1� S 1. �_ a ar bwi.ir .J.7 Place of Burial (or Removal) ._U__e___c f G/e—i.i .ru.i (If body is to be temporarily held, fill in space later) ! �' Cemetery___.!�' e /=°ems �u %s �, (P, H.`* �Date of Burial 3 ) — 19_2, (if body is tobe temporarily held, fill in space later) The CERTIFICATE OF DEATH containing the above stated particulars, having been presented to me, after careful examination, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW, I have accepted the same for registration, have recorded it in my Local Record with the above stated Registered Number, and on the basis thereof I HERE- BY GRANT A PERMIT to S: cflt e .- V [t-4-1 e t I - ^- �� _L1/_.ar_re...- -S-X. /> ....t fc4_ls._._J2_7/f ' (Name) (Address) _ ll�the mr1 r-.k--,), e- to hold temporarily and —/--h the 'hod (Unlertaker or person having charge of corpse) (Inter, remov therwise prise of (state how)) Dated .2._ — , 19 )o (Signed) �k.. ?' a Local gistrar This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to loc cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No. 62) is required. FORM VS. 61. (REV. 6/63) (6A2-130) ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON WHCH INTERMENTS OR CREMATIONS AR MADE I 97t-li Date of was j11/ 19 (Interment or (a„-..s.-:1--.6__., k------e-- .{.1.."-'‘ (Name of Cemetery, Cr oryunarert ' Section ��L ' Lot No. ve No. (Signed) (Person In Charge) z-P1--3 a--/6 4--7,1.44----- +.�, - "', ,. in 1 t r• ''" its Permit to the Registrar of his District within SEVEN (7) DAYS from above date. If no person is in charge, the FUNERAL DIRECTOR or UNDERTAKER MUST SIGN ABOVE STATEMENT, write across the face of the Permit the words "No person in charge," and FILE PERMIT WITHIN THREE (3) DAYS with the Registrar of District in which cemetery is located. SEXTONS, FUNERAL DIRECTORS and UNDER- TAKERS violating the law relative to the return of permits are liable to a penalty of NOT LESS THAN FIVE DOL- LARS NOR MORE THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law will be enforced. Local Regis- trars are required, under penalty, to report violations thereof. '�horm VS-67 (rev. 11/65) NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records FUNERAL DIRECTOR or UNDERTAKER'S REQUEST TO DISINTER BODY In completing this form, please typewrite, hand-print or write legibly all entries in permanent black or blue black ink. Signatures should be legible. This is a permanent record. When data cannot be obtained, write "UNKNOWN" in applicable spaces. I hereby request permission to disinter the dead body of: Nome c j„Oeces sled S ❑ Male Age(yrs.) ..1-.c q 11 C "C �"'Z . in Female 2/ Place of Death (indicate .whether cityf/village or town) Date of Death Cause of Death C etery now ' t rrAd '` / Loca ' n (city,town or coup y) Is body to be transported by common carrier? a 11 C Y I C 'S' t /_/ t`i•-t ✓-t•c17 r r` iy ❑ Yes IVI No Stat fully the final disposition to be made of body. - /l 7C TPIP' - ,6c-, 1 h31-'LY"C et !:a of place or.ce etery tof in 1 dis osition Date of nna dis�ppoosition FIT roe Reg. No. Address 1 < C �,t V2 i Cry r 5 c `�v-e, $7 i.�h, .?s; �y Signette of Funeral Director V dert ker �/a Reg. No. Date vir/?tiro a. INSTRUCTIONS TO FUNERAL DIRECTOR OR UNDERTAKER: 1. See Section 13.1 (formerly Chapter Xlll, subdivision 4) of the Sanitary Code, relating to the transportation of dead bodies by common carriers, as printed on the back of the Transit Label. 2. The data required concerning the decedent may be obtained from the local register or cemetery record. INSTRUCTIONS TO LOCAL REGISTRAR: 1. For bodies to be transported by common carrier, fill out Transit Permit. 2. For bodies not to be transported by common carrier, fill out ordinary Official Burial (or Removal) Permit. 3. In each case write the word "DISINTERMENT" on the Permit. 4. This form should be filed and carefully preserved in your office.